Symptoms of Lung Cancer Emergencies: When to Go to the Hospital

Knowing the signs and symptoms of an emergency with lung cancer is important in order to get prompt treatment. Difficulty breathing, coughing up blood, a change in mental status, a fever, feeling lightheaded, or sudden leg weakness with or without bowel or bladder problems should prompt you to call 911 without hesitating. That said, it can be hard to recognize serious symptoms amidst the "normal" symptoms of shortness of breath and chest pain many people experience with lung cancer.

Since emergencies don't necessarily mean a cancer is terminal, and these symptoms may occur even with a highly curable lung cancer, it's important that everyone living with the disease (and their loved ones) know when to recognize the warning signs. With prompt care, even serious conditions can often be treated when caught early.

1

Difficulty Breathing

Many people if not most with lung cancer experience some breathing difficulty, so how can you know when your symptoms are an emergency?

Certainly there are signs and symptoms associated with difficulty breathing that make calling 911 a wise choice. Symptoms such as a sudden onset of a sudden change in breathing, or a bluish discoloration of your skin and lips (cyanosis), are a reason to call. A tightening of the neck muscles while breathing (referred to as "the use of accessory muscles") raises the chance that your symptoms are serious.

But again, your "gut" feeling often speaks volumes. If you feel concerned that your breathing has changed in any way, even if you can't describe it, make the call.

If you are feeling frightened by your breathing, you should call 911.

Another setting in which making a call important is if breathing feels tiring. Most often breathing is something you do without conscience awareness. Even being aware of your breathing could mean something has changed. By the time your breathing has become tiring, your symptoms are likely very serious.

If trying to breathe becomes tiring, you should call 911.

Enlist the Help of Friends and Loved Ones

If you aren't sure how bad your breathing is, have someone count and record the number of breaths you take each minute. A normal respiratory rate is 20 breaths per minute or less at rest, while a respiratory rate over 24 may indicate a very serious condition. Respiratory rate has been called the ignored vital sign and is very important in predicting serious medical events. 

As noted earlier, trust your gut. Even if your breathing rate is normal and your skin is pink, a sensation of shortness of breath, especially if it is causing you to worry, should be checked out immediately.

If your "gut" tells you something is wrong, call 911.

2

Coughing up Blood

Coughing up blood, even a small amount, should prompt you to call 911. Coughing up even a teaspoon of blood is a medical emergency. It may not look like a lot of blood, but keep in mind that coughing up 100 cc of blood, or 1/3 of a cup of blood (called massive hemoptysis) is considered a life-threatening emergency. 

Coughing up even a very small amount of blood is a medical emergency.

The problem is that bleeding in this area can quickly lead to airway obstruction (inability to get air into the lungs), aspiration (breathing the blood into the lungs), and a severe drop in blood pressure. Coughing up smaller amount than this can become serious very quickly, so you should be alert even if you notice just a drop of two on a tissue.

Among people who don't have lung cancer, there are many potential reasons for coughing up blood. Yet with lung cancer, this is often caused by a tumor growing into a vital area such as a blood vessel, or low platelets due to chemotherapy.

Don't wait. Call 911.

3

Chest Pain

Chest pain, or what feels like "lung pain" can be an emergency for people with lung cancer. Not only are there many possible causes of chest pain related to lung cancer and cancer treatments, but people with cancer can develop heart disease as well. It's easy to forget amid treatment that people with lung cancer suffer from the same medical concerns as people without lung cancer when it comes to heart disease, and many treatments for cancer can actually increase this risk. (Some chemotherapy drugs, as well as radiation to the chest, can cause heart disease.)

We've also learned that chest pain related to heart disease can differ in women, and the "typical" symptoms of crushing chest pain on the left side is often absent. In fact, this lack of typical symptoms is thought to be one of the reasons why women tend to do poorer after a heart attack than men. Instead, women may experience symptoms such as profound fatigue, heartburn, or vague chest discomfort; symptoms that again can easily be confused with "normal" symptoms related to lung cancer.

The sudden onset of chest pain is a reason to call 911, and unlike instructions given to people without cancer to watch for dull, crushing pain, sharp pain can be just as serious for people with cancer.

Being aware of what is normal for you as far as symptoms is extremely important. Chest pain is common for people with lung cancer, whether related to post-thoractomy pain syndrome due to lung cancer surgery, pleuritic chest pain due to a pleural effusion, or other causes. Some people find it helpful to rank their pain with a number. For example, if the pain you are experiencing would be considered a 5 on a scale of 1 to 10 with regards to severity, and your "usual" pain level is a 3, you may wish to call 911.

4

Sudden Change in Mental Status

A sudden change in mental status can be an emergency for people living with lung cancer. There are many possible causes of confusion, including hypercalcemia of malignancy, brain metastases, and more, but the important thing is not determining a cause but being ready to call 911 if a person is truly confused.

Symptoms may include hallucinations, agitation, and anything you would interpret as confusion or "being off" as a teen would say. Sometimes it's hard to tell if a person is truly confused, if they are experiencing a side effect of a medication, simply anxious, or in pain. If you have any doubt, call 911.

5

Fainting or Severe Lightheadedness

Loss of consciousness (syncope) or a feeling like you may lose consciousness, is a reason to call 911 with lung cancer. There are many complications of lung cancer involving several body systems that can cause this symptom, but the important thing is getting medical attention as soon as possible.

Your family and friends should be aware of when to call 911 if you are unable to let them know—such as in this scenario. Share with your loved ones this list of symptoms which suggest an emergency and have a list of your current diagnosis, medications, and treatments handy in the event someone else needs to speak for you. Don't assume the paramedics or even the hospital, will have this information. (Sometimes an ambulance will take a person to a hospital other than their usual hospital for a number of reasons.)

Check out these signs and symptoms that you are about to faint and watch for these symptoms:

  • Sweating
  • Confusion
  • Sudden decrease in hearing
  • A sensation of tunnel vision
  • Nausea
  • Flushing
  • Trembling

If you are feeling faint, alert a family member to call 911, and get into a position in which you won't be injured if you lose consciousness. It's often recommended to sit down with your head between your knees, but even this could be dangerous as a fall from a chair could risk injury. Don't wait to see if your symptoms pass, even if you believe there is a good reason for your symptoms.

6

Face, Neck, or Tongue Swelling

 Anaphylactic shock, the most severe form of allergic reaction, often accompanied by a profound drop in blood pressure, is an emergency for people with lung cancer. With the array of medications many people are on during lung cancer treatment—many of which can cause allergic reactions—any sign of a serious allergic reaction should be heeded.

A special type of allergic reaction called angioedema can occur in people using chemotherapy drugs such as Taxol (paclitaxel). This often causes profound swelling of the face, especially the skin around the eyes and the tongue. With both of these conditions, people may develop intense itching, wheezing, weakness, and eventually unconsciousness. 

Superior vena cava syndrome may also be a medical emergency for people with lung cancer. With this syndrome, pressure on nearby structures from a tumor near the top of lungs can cause a feeling of fullness in the head, dilated neck veins, and chest swelling.

7

Sudden Leg Weakness/Numbness or Loss of Bowel/Bladder Control

Spinal cord compression (SCC) due to lung cancer that has spread to bone, can lead to a medical emergency—or at least a situation in which quick treatment may help to preserve function. Symptoms of spinal cord compression often begin with pain in the back or neck.

Serious weakness or numbness of an extremity (or two) and loss of bowel or bladder control due to SCC is referred to as "cauda equina syndrome." This is a serious emergency which should prompt calling 911.

There are several ways in which spinal cord compression may occur in people with lung cancer, but the important thing to know is that this is an emergency. Even in cancers with a poor survival rate, emergency surgical treatment may be able to preserve function of the legs, bowel, and bladder for the time that is left.

8

Fever

A fever can be a medical emergency with lung cancer, but the temperature at which this becomes an emergency will vary between people and what treatments are being given.

We list this as an emergency because despite having good antibiotics, there are lung cancer survivors every year who don't make it to the ER in time for antibiotics to work.

A temperature of 101 F (or 100.5 F) is often cited as the level at which to at least call your doctor, but this will be different for everyone. Treatments such as chemotherapy for lung cancer, can lower the ability of the body to fight infection, and antibiotics that would ordinarily be used for some people,may not be effective; never use an old prescription for antibiotics that you have on hand.

Sepsis and septic shock syndrome are clear examples of emergencies for which people with lung cancer should call 911. In addition to a fever, people often have other symptoms, such as lightheadedness, a rapid heart rate, confusion, and shaking. It's important to note that some people with sepsis, instead of having a fever, have a low body temperature (hypothermia), so a normal temperature is not necessarily a reassuring sign with respect to an infection.

Talk to your doctor about what your "warning" temperature should be ahead of time. If you are on chemotherapy, be extra alert for a fever. Even if your white blood cell count is normal or low normal, it's thought that, in some cases, the white blood cells people have may not work as well during chemotherapy.

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  3. American Cancer Society. Confusion.

  4. American Heart Association. Syncope (Fainting).

  5. Food and Drug Administration. Taxol Injection Product Label.

  6. Rider IS. Cauda Equina And Conus Medullaris Syndromes. StatPearls [Internet].  2019.

Additional Reading
  • Johns Hopkins Medicine. Spinal Cord Compression.

  • Bast, R., Croce, C., Hait, W. et al. Holland-Frei Cancer Medicine. Respiratory Oncology Emergencies. Wiley Blackwell, 2017.